IgE-Selective Immunoadsorption for Severe Atopic Dermatitis

Abstract

Introduction: Recent reports proposed the application of immunoadsorption (IA) for patients with recalcitrant atopic dermatitis (AD) and high-serum IgE levels. However, experience with this novel treatment approach, especially with the newly available IgE-specific adsorber, is limited and recommendation for its use in clinical practice awaits evidence from more studies.

Materials and methods: Patients with severe AD (SCORAD ≥ 60) and total serum IgE levels ≥750 kU/L were included in this study. The treatment protocol consisted of two cycles of five consecutive treatments with IgE-selective IA 3 weeks apart.

Results: Ten patients were enrolled and four patients completed the study. The mean SCORAD was significantly improved by up to 43% within a few weeks and until the end of a 6-month follow-up period, with 50% of patients achieving an at least 50% individual reduction of the baseline SCORAD. Each IA cycle induced a temporal average decrement of total serum levels of IgE, IgM, IgA, and IgG by 92, 43, 38, and 35%, respectively. Except for one case of Staphylococcus aureus septicemia, no major adverse events occurred.

Conclusion: Although limited by a considerable withdrawal rate, our observations strengthen our and other recent results further suggesting that IgE-selective IA is an effective treatment option for patients severely affected by AD with highly elevated IgE levels.

Keywords: IgE; SCORAD; atopic dermatitis; immunoadsorption; immunoglobulin.

Figure 1

Representative presentation of a study patient before (week 1) and after immunoadsorption (IA) (week 3).

Figure 2

Time-dependent mean SCORAD changes following immunoadsorption (IA). n = 3–8 patients (8, 5, 8, 5, 3, 3, and 4 patients at week 1, 3, 5, 9, 13, 17, and 25, respectively). *P < 0.05, **P < 0.01, and ***P < 0.001.

Figure 3

Effects of immunoadsorption (IA) on serum immunoglobulin levels. Box plots of peripheral IgE, IgM, IgA, and IgG levels of the study patients before and after each IA cycle; n = 6–8 patients (varying by time point and analyte).